Provider Demographics
NPI:1376031641
Name:DIAL, CAROL AILEEN (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:AILEEN
Last Name:DIAL
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MISS
Other - First Name:CAROL
Other - Middle Name:AILEEN
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9805 GEIST CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-4819
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9805 GEIST CROSSING DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-4819
Practice Address - Country:US
Practice Address - Phone:317-577-1353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71008029A363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily